Transcript – Neal Barnard, clinical researcher and founder of the Physicians Committee for Responsible Medicine (PCRM), discusses on Tackling Diabetes With a Bold New Dietary Approach at TEDxFremont conference
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Neal Barnard – Clinical Researcher, Founder, the Physicians Committee for Responsible Medicine
Today, I’d like to talk about turning around an epidemic. 100 million Americans right now do have either diabetes or pre-diabetes, and that puts them at risk for amputations, for heart disease, for blindness and we’re exporting this epidemic overseas.
Now the word epidemic comes from Old Greek: ‘epi’ means ‘on’, ‘demos’ means ‘people’, so an epidemic is something we study with sterile statistics, and maps, and graphs, but the truth is, it’s something that impinges directly on people, on living, breathing human-beings.
But my story actually starts in the basement of a Minneapolis hospital. The year before I went to medical school, I was the morgue attendant, or as I’d like to say, the autopsy assistant. What that meant was, whenever anybody died, I would bring the body out of the cooler, and put the body on an examination table, and the pathologist would come into the room.
And one day, a person died in a hospital of a massive heart attack. Probably from eating hospital food, but that’s another story.
So to examine the heart, you have to remove a section of ribs, and this is not done with great delicacy: you take what looks like a garden clipper, and you go crunch, crunch, crunch, through the ribs on this side, and crunch, crunch, crunch, through the ribs on this side. And the pathologist pulled this big high wedge of ribs off the chest, set it on the table.
And he knew I was going to be going to medical school, so he wanted to make sure that I saw everything. And he would say, “Neal, look at this. These are the coronary arteries,” — we call them coronary because they crown the heart — and he sliced one open, and he said, “Look inside.”
And so with my gloved finger, I poked around, and it wasn’t a wide open artery, it had what was sort of like chewing gum inside, except that it was hard like a rock, and he said, “That’s your bacon and eggs, Neal, that’s atherosclerosis.”
And we looked at the carotid arteries going to the brain, the arteries going to the legs, the arteries going to the kidneys. They all had this hardening of the arteries, that’s atherosclerosis.
He said, “We see the beginnings of this in two-thirds of people by age 23”, which happened to be the exact age that I was at the time. So, anyway, he writes up his findings, “massive atherosclerosis, acute myocardial infarction,” and he leaves the room.
So, I picked up the ribs and put them back in the chest, tried to make them fit right with the other ribs, and I sewed up the skin, and cleaned up, and then I went out and went up to the cafeteria, where it turned out they were serving ribs for lunch.
Now, let me tell you something, I knew about ribs. I grew up in Fargo, North Dakota, I come from a long line of cattle ranchers and I remember the smell of the cows out in the field, I remember the smell of the cows in my grandpa’s barn and I remember driving a load of cattle with my uncle to East Saint Louis, to the National Stockyards, and I remember the National Stockyards hotel, two dollars a night, and the smell of that room.
And I have to say, everyday in my life, it was roast beef, baked potatoes, and corn. Except for special occasions, when it was roast beef, baked potatoes, and peas. And that’s the sort of the way we ate, but my father did not like the cattle business, so he left, left the family farm, and he went to medical school.
And he spent his life at the Fargo clinic treating diabetes, he became a diabetes expert for the whole region. And I have to say my father really was frustrated because patients were given diets that they did not like. What we would say is, or what they would say, is diabetes is a condition where it’s too much sugar in your blood, so don’t eat anything that turns to sugar, so don’t eat bread, don’t eat fruit, don’t eat pasta, rice, sweet potatoes, don’t eat regular potatoes, don’t eat beans, don’t eat carrots; all these things had to be limited and while you are at it, cut calories, and that’s what people were supposed to adhere to, that gets old by Wednesday.
Patients were also given medicines, and they were given needles, and instructions on how to stick their fingers and how to inject insulin. And despite all of this, diabetes never got better, it always progressed, and it then became something that we’re exporting overseas.
And when I got out of medical school, we had more medicines, and I think we had sharper needles, but to tell you the truth, it was the same sort of result, we had unhappy patients, and we’ve never ever cured this disease, it never turned around, it was always considered a progressive disease.
But there were two scientific discoveries that really turned all this around. And the first one was taking the widest possible lens. If you look around the world, at those countries that have the least diabetes, like Japan, for example, they weren’t following anything like the diet we were given to diabetic patients. They weren’t saying, “I’m not going to eat rice, I won’t eat noodles,” they eat this kind of food all the time, it’s front and center on their plate.
And the second discovery came from looking inside the cell, especially the muscle cell. And the reason we look at muscle cells in particular is that’s where glucose is going, that’s where blood sugar is going, that’s the fuel that powers your movement.
Do you know about a person who’s running a marathon? What are they doing in the weeks leading up for it? They’re carbo-loading. So they’re eating pasta, they’re eating bread to try to get that glucose into the cell for energy. And that is the problem in diabetes, because glucose, glucose is there, outside the cell, trying to get inside. In order to get in, it needs a key. And that key is insulin.
Now, what if I get home, and I’m getting up to my front door and I take my key out of my pocket, I put it in the front door — Wait a minute, it’s not working. And there’s nothing wrong with my key, but I look in the lock, and while I was gone, somebody put chewing gum in my lock. So what am I going to do? Crawling in and out the window? No. I’m going to clean out the lock.
Well, when a person has diabetes, their insulin key is not working. Why would that be? Why could insulin not signal? What supposed to happen is the glucose is supposed to enter into the cell. And glucose is the key that makes that happen. But the reason it doesn’t happen it’s not that there’s chewing gum inside the cell. What there is is fat. Fat, little globules of fat.
Now I have to say, doctors hate words like “fat”, it’s got one syllable. So we want to call it intramyocellular lipid. ‘Intra’ means’ inside’, ‘myo’ means ‘muscle’, ‘cellular’ means ‘cellular’, ‘lipid’ means ‘fat’. Intramyocellular lipid is fat inside your muscle cells, and that is what interferes with insulin’s ability to work like a key to signal glucose coming in.
In 2003, The National Institute of Health gave my research team a grant and said, “Let’s test something completely different. Instead of limiting breads and all these kinds of things, what if – if fat is the issue, what if we have a diet that has effectively no fat in it?”
Well, where does fat come from? It comes from two sources: animal products, animal fat, and vegetable oils. So we brought in 99 people, and we asked them to do two things: to really eat a bounty of food and not worrying about quantity, we’re not counting calories here, we’re not counting carb grams or anything like that. What we’re doing instead is we’re setting the animal products aside keeping the vegetable oils low. Very simple.
Now one of our participants was a man named Vance, and Vance’s father was dead by age 30. Vance was 31 when he was diagnosed with diabetes, he was in his late 30s when he came to see us. And he said, “This is not hard!” Unlike every other diet he’d been on, we didn’t care how many carbs he ate, or how many calories, or how many portions. If he was having chilli, not a meat chilli, would be a bean chilli, chunky vegetable chilli. If he was having spaghetti, instead of a meat topping, it would be topped with artichoke hearts and wild mushrooms, and chunky tomato sauce. So that kind of thing; very, very easy.
Over the course of about a year, he lost 60 pounds, his blood sugar came down and down, and down, and one day his doctor sat him down and said, “Vance, I know you’ve had family members die of this disease.” But he said, “I look at your blood tests; you don’t have it anymore.”